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PILE HAMMER PRE-MOB INSPECTION REPORT


Applies to Diesel Pile Hammer

Equip. No. : Type : Model : Brand :

Serial No. : Hourmeter : Service Date :

Inspected by : Date : Location : Owner :

d
Description to be Checked

oo
Remarks

/A
oo

N
G

o
N
Equipment Documentation
1 Today's Pre-Trip Inspection Original Copy Available on Unit
2 Original Manufacturer Name Plate Year of Manufacture:
3 Original or a Copy of Operation Manual Book Matches Unit Type and Series
4 SOP - Standard Operating Procedure Based on OEM Operation Manual Book
5 Company ID Number, Company Logo Correct Size, Minimum 10 Cm Height, Visible

Mandatory Safety Inspections and Devices


1 Lifting Trip Lock System Check Function, Not Worn Out, Not Damaged or Bent
2 Pile Hammer Leads Clamps Not Worn Out, Good General Condition, No Cracks, Good Lubrication
Shackle and Pin Correct Size, Safety Pin Installed, Can not Fall Off or Wind Undone, Can
3
Not Release by Itself
Hammer Head Buffer Wood
4
Made of Suitable Shock Absorbing Hard Wood Material, Suitably Sacrificial
Safety Covers and Guards
5
All Covers in Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs

Main Units :
1 Cylinder Housing Good Clean General Condition, Good Lubrication
2 Hammer Piston Good Clean General Condition, Good Lubrication
3 Fuel Pump No Leaks, Test Function
4 Fuel Line Condition Properly Secured, No Leaks, Test Function
5 Tag Line Made of Good Rope, Good Clean General Condition

Servicing and Maintenance


1 Maintenance Schedule - PM and PdM Service Records Available

Others
1
2
3

Comments
Good = Good condition, able to be operated in
all CPI areas
No Good = Broken, Malfunction, Repair or Replace

N/A = Not Applicable

Inspected by: Acknowledged by RW and CPI The undersigned hereby accept and agree
that this equipment is "OK" and safe for
operation. Menerima dan Menyetujui bahwa
Alat ini sudah "OK" dan aman untuk
dioperasikan.

SIGNATURE, Date

RW-CEM RW-HES
Contractor's Name
C-029-RW-12 - Rev-1 - Oct-12